Ketogenic diet

Certain children who are having problems with medications, or whose seizures are not being well controlled, may be placed on a special diet called the ketogenic diet.

Video: What is the ketogenic diet, and how does it help with epilepsy?

Dr. Patel, pediatric neurologist, explains the ketogenic diet and how it helps with epilepsy.

What is a ketogenic diet?
The ketogenic diet is sometimes offered to those children who continue to have seizures while on seizure medication. When the medications do not work, a ketogenic diet may be considered. No one knows exactly how the diet works, but some children do become seizure-free when put on the diet. However, the diet does not work for everyone.

What does the diet consist of?
The ketogenic diet is very high in fat (about 90 percent of the calories come from fat). Protein is given in amounts to help promote growth. A very small amount of carbohydrate is included in the diet. This very high- fat, low- carbohydrate diet causes the body to make ketones. Ketones are made by the body from fat. They are made for energy when the body does not get enough carbohydrates for energy. If your child eats too many carbohydrates, then his/her body may not make ketones. The presence of ketones is important to the success of the diet.

High-fat foods (ketogenic diet friendly):

• Butter
• Heavy cream
• Vegetable oil
• Mayonnaise
• Bacon
• Cheese

High-carbohydrate foods (not ketogenic diet friendly):

• Fruit and fruit juice
• Breads and cereals
• Vegetables (corn, peas, and potatoes)
• Beans
• Milk
• Soda
• Snack foods (chips, snack cakes, crackers)
• Sweets

Sample ketogenic meal:

• 60 g. heavy cream
• 24 g. cooked broccoli
• 21 g. chicken breast
• 29 g. butter

What to expect
Your child's physician will determine if this diet is right for your child. When the ketogenic diet is started, your child will be admitted to the hospital. The diet will be introduced gradually over three days. During this time the dietitian will teach you how to plan and manage the diet at home.

You will also be taught how to check your child's urine for ketones. The dietitian will help determine how much fat, protein, and carbohydrate your child is allowed to have, usually divided into three meals a day. The ketogenic diet can by very challenging to prepare and requires that all foods be weighed using a food scale. The ketogenic diet is not nutritionally balanced, therefore, vitamin and mineral supplements will be prescribed.

Some medications and other products, such as toothpaste and mouthwash, contain carbohydrates. It is important to avoid these products if your child is on the ketogenic diet. Your child may not make ketones in their urine if too many carbohydrates are included in the diet. Your child's physician and dietitian can give you a list of medications, and other products, that are free of carbohydrates.

The ketogenic diet also can be prepared in liquid form for children with feeding tubes and for bottle-fed infants.

Will medicines change after starting this diet? 
Most often, the diet is started along with all current medicines. Liquid or chewable medicines may need to be changed to a form with less carbohydrate. If the diet helps to improve seizures, medicines may be changed in the future.

Are there any side effects of the diet?
Constipation is the most common side effect. The diet may also increase acid in the body. This is called acidosis. A less common effect is kidney stones. Drinking enough fluid and taking prescribed supplements will help to prevent these issues. While on the ketogenic diet, food alone will not provide enough vitamins or minerals. Your child will need to take vitamin and mineral supplements. The healthcare provider will prescribe these. Although this diet is high in fat, most children will not gain too much weight or get high cholesterol while on the diet.

What follow-up care is needed while on this diet?
Routine follow-up clinic visits are needed. At each visit, the dietitian will look at growth and nutrition. Blood work will be done to see how the body is handling the diet. Changes will be made to the diet or medicines to get the best seizure control.

How long is the diet used? 
Children usually stay on the diet about two years. The diet is then slowly changed back to a regular diet.